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La rupture spontanée du tendon quadricipital est rare, ainsi qu'une atteinte bilatérale et simultanée. Nous rapportons un patient de 53 ans suivi pour adénome parathyroïdien compliqué d'insuffisance rénale, admis pour rupture bilatérale et spontanée des deux tendons quadricipitaux. Il a bénéficié d'une réparation chirurgicale qui lui a permis une autonomie.

Previous studies showed that changes in peak of oxygen uptake value (VOThe aim of the study was to compare the responses to exercise training of electromyographic activities of vastus lateralis (rms-EMG) and respiratory parameters.Nine cardiac patients (64.0±3.1y, 172.9±4.8cm, 83.4±16.3kg, BMI: 27.8±4.5) performed an incremental cycling exercise test to determine MTP, VOShort-term exercise training (23.7±8.8 days) induced a significant increase in VOThis might be taken into account for prescribing exercise rehabilitation according initial clinical limitations of patients.

Exercise prescription was generally based on the determination of ventilatory thresholds (VTTo observe the occurrence of EMGtThirty-four CP (62.1±7.3years, 172.1±6.3cm, 81.3±15.3kg, BMI: 27.3±4.1) performed a cycle CPX at a 60-rpm cadence. VTPeak values of oxygen uptake (16.3±4.6mL·minThe EMG

Patients with COPD frequently have lower strength and endurance in their lower limbs compared to healthy subjects and evaluation of their quadriceps strength is recommended in practice. The handheld dynamometer has been validated and is easy to use for this measurement but its reproducibility has never been studied for endurance evaluation and only poorly for strength. The objective of this study was to estimate the inter and intra-operator reproducibility of maximal voluntary strength and endurance measurements of the quadriceps with a handheld dynamometer in patients with COPD.The measurements of maximal voluntary strength and endurance were performed with a single handheld dynamometer using isometric contraction. Three measurement sessions were undertaken, separated by 24hours. The intra- and interoperator reproducibility were estimated by calculation of the intraclass correlation coefficient.Overall, 21 patients were included in the study. The intraclass correlation coefficient calculated for the maximal voluntary strength for intra and interoperator reliability ranged between 0.95 and 0.99. For endurance, the coefficient for intra-operator reliability was 0.81 and the two for interoperator reliability were 0.69 and 0.77.The handheld dynamometer allows an excellent inter and intra-operator reproducibility for the measurement of quadricipital maximal voluntary strength and a correct to excellent reproducibility for the measurement of quadricipital endurance. This tool may be used for the evaluation of quadriceps strength in clinical practice in COPD patients, particularly during rehabilitation.

During football several joints are greatly demanded, especially the knees.The interest of the isokinetic is to detect an imbalance between agonist and antagonist muscles of the muscle leg and between dominant and non dominant leg, in order to prevent injuries and to improve the physical fitness of young soccer players.evaluate the isokinetic profile of flexor and extensor muscles of the knee of competitive footballers Methods : Prospective study conducted in the department of Physical and Rehabilitation Medicine of the Military Tunis Hospital, including 15 competitive footballers and evaluated during the month of August 2012. All patients underwent an isokinetic assessment of agonist and antagonist muscles of the knees in concentric mode 3 speed 60 ° / 120 ° and 180 ° (with analysis of figures and curves), using a Biodex dynamometer. The selected parameters were the time of maximum force (MFM) of the knee flexors and extensors, and the agonists / antagonists ratio (IJ / Q). The data were analyzed by SPSS software.15 competitive footballers were included. The average age is 23.20 years ± 3.99 years, ranging from 18 to 28 years. The average size is 167.13 cm ± 3.6 cm with a range of 163 and 172 cm. The average weight is 60.87 kg ± 5.97 with a range of 50 to 70 kg. The isokinetic evaluation showed a statistically significant superiority of the flexor muscles of the right knee compared with those of the left knee at the speed 60 / s (p = 0.046) and 120 / s (p = 0.031), whereas this difference has not been found for the extensors muscles. The values of the ratio of quadriceps to hamstring increases with the speed of movement performed, the maximum moment / weight moving in the opposite direction.The isokinetic evaluation allows an objective assessment of the flexor and extensor muscles of the knee footballers, in order to correct imbalance and preserve the sporting future of the young footballers.

Les ruptures traumatiques du tendon quadricipital sont rares, elles surviennent préférentiellement après 40 ans, suite à un traumatisme indirect chez le sportif (flexion contrariée du genou) ou traumatisme banal chez le sédentaire. La tendinopathie préexistante est fréquente. La rupture est le plus souvent totale et siège au corps du tendon 60% des cas ou décallotement quadricipital au bord supérieur de la rotule (40% des cas). Le diagnostic est essentiellement clinique. Les examens complémentaires (échographie et imagerie par résonance magnétique) sont utiles et appuient le diagnostique, mais sont souvent faussement rassurants hormis la radiographie qui montre une rotule basse. Le traitement essentiellement chirurgical associé à la rééducation fonctionnelle donne des résultats largement meilleurs. Le délai d'intervention est un facteur pronostic très important. Les auteurs rapportent 03cas de rupture de tendon quadricipital. L’âge moyen est de 50ans. Ils ont été traités chirurgicalement et revus régulièrement, avec un recul de 16 mois pour apprécier l’évolution. Les résultats ont été très bons chez 02 cas et bon chez 01 cas. L'amélioration a été très nette selon les critères: marche, douleur et reprise d'activité physique.

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We present the case of a 54 year-old man presenting with a right Brown-Séquard plus syndrome (BSPS) after a traumatic cervical spinal cord injury. After being operated on with selective tibial neurotomy and triceps surae lengthening because of a right spastic equinus foot, he developed a gait disorder at high speed. The patient complained about an instability of the right knee. Observational gait analysis exhibited an oscillating, flexion/extension motion of the right knee during stance, which was confirmed by gait analysis. Dynamic electromyographic recordings exhibited a clonus of the right rectus femoris (RF) during stance. The spastic activity of the RF and the abnormal knee motion totally reversed after a motor nerve block of the RF, as well as after botulinum toxin type A injection into the RF. We emphasize that complex, spastic gait disorders can benefit from a comprehensive assessment including gait analysis and nerve blocks.

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Chronic obstructive pulmonary disease (COPD) is often accompanied by skeletal muscle alterations, resulting in enhanced morbidity and mortality.Many studies have highlighted important structural and biochemical modifications in limb and respiratory muscles in COPD. Reviewing the similarities and differences between the two most studied muscles in COPD, the quadriceps and the diaphragm, may provide important clues about the mechanisms dictating muscle changes that occur in this disease.Though these two muscle groups share a common systemic environment, discrepancies are observed in their respective alterations. These phenotypic differences suggest that, in addition to systemic factors, the local microenvironment must participate in the reorganization seen in these two muscles in COPD.The current review introduces the alterations observed in the quadriceps and diaphragm in the context of COPD and suggests possible signaling pathways involved in the development of muscle dysfunction.

Objective To evaluate trunk and knee muscle strength in patients with chronic sciatica. Patients and method Twenty-eight patients with right-side chronic sciatica (group 1, G1) and 40 healthy controls (group 2, G2) were evaluated using an isokinetic dynamometer (Cybex Norm II). Quadriceps and hamstring muscle strength were evaluated at concentric velocities of 60 and 120°/s and the trunk muscles were evaluated at concentric velocities of 60 and 90°/s. Results G1 comprised 15 women and 13 men (mean ± SD age: 34.787 ± 6.06; weight: 65.85 ± 5.33 kg; height: 165 ± 6.92 cm). G2 comprised 20 women and 20 men (mean ± SD age: 35.92 ± 6.66; weight: 67.07 ± 6.12 kg; height: 165.82 ± 7.65 cm. There were no significant inter-group differences concerning these parameters. In G1, the peak torque values for the trunk extensors were 123.71 ± 32.45 and 108.85 ± 32.07 Newton metres (Nm) at angular velocities of 60 and 90°/s, respectively. In G2, the values were 192.73 ± 64.24 and 168.65 ± 53.96 Nm, respectively. In G1, the peak torque values for the trunk flexors were 134.32 ± 30.77 and 124.39 ± 32.59 Nm at angular velocities of 60 and 90°/s, respectively. In G2, they were 177.44 ± 44.1 and 157.81 ± 39.01 Nm, respectively. The difference between G1 and G2 was statistically significant. The peak torque for the right quadriceps in G1 was 100.03 ± 24.45 and 78.71 ± 22.92 Nm at angular velocities of 60 and 120°/s, respectively. In G2, these values were 160.5 ± 36.34 and 131.05 ± 33.42 Nm. The peak torque for the hamstrings in G1 was 56.42 ± 13.02 and 50 ± 13.55 Nm at angular velocities of 60 and 120°/s, respectively. In G2, these values were 97.77 ± 33.32 and 84.72 ± 31.41 Nm. Again the difference between G1 and G2 was statistically significant. We also noted a statistically significant difference between G1 and G2 in terms of the peak quadriceps and hamstring torque values on the left side. In G1, the quadriceps and hamstrings were significantly weaker on the sciatica side than on the unaffected side. Conclusion The present study demonstrated trunk and knee muscle weakness in patients with chronic sciatica, when compared with healthy subjects. This weakness was predominant on the sciatica side. Consequently, the management of these patients should include a knee muscle reinforcement programme.

This retrospective multicentric study was designed to assess the outcome of quadriceps and hamstrings muscles two years after Anterior Cruciate Ligament (ACL) reconstruction and compare muscles recovery depending on the type of graft and individual variables like age, gender, level of sport, but also in terms of discomfort, pain and functional score. The results focused on the subjective and objective IKDC scores, SF36, the existence or not of subjective disorders and their location. The review included isokinetic muscle tests concentric and eccentric extensors/flexors but also internal rotators/external rotators with analysis of mean work and mean power. One hundred and twenty-seven patients were included with an average age 29 years (+/-10). They all had an ACL reconstruction with patellar tendon or hamstring tendon with single or double bundles. In the serie, the average muscles deficit at two years was 10% for the flexors and extensors but with a significant dispersion. Significant differences were not noted in the mean values of all parameters in term of sex or age (over 30 years or not), neither the type of sport, nor of clinical assessment (Class A and B of objective IKDC score), nor the existence of anterior knee pain. There was a relationship between the level of extensor or flexor recovery and the quality of functional results with minimal muscle deficits close to 5% if the IKDC score was over 90 and deficits falling to 15% in the group with IKDC score less than 90. The type of reconstruction (patellar tendon versus hamstrings) had an influence on the muscle deficit. For extensors, the recovery was the same in the two groups, more than 90% at two years and the distribution of these two populations by level of deficit was quite the same. For flexors, residual deficits were significantly higher in the hamstrings group on the three studied parameters whatever the speed and the type of contraction (concentric or eccentric) with an average deficit of 14 to 18%, while, in the patellar tendon group, there was a dominance over the opposite side of 2 to 3% in concentric contraction. The hamstrings deficit appears to be "harvest dependent". For internal rotators, a significantly higher deficit is observed in eccentric contraction for the hamstrings group. The residual hamstrings deficits were related to the number of tendons harvested: -7% when there was no harvest, 7% with one tendon harvested and 17% with two tendons harvested. The relationship between the level of recovery of the quadriceps muscle and hamstrings at two years and the quality of functional results incite, regarding the significantly higher deficit of flexors in ACL reconstructions with hamstrings, to change the rehabilitation programs and especially on early rehabilitation of hamstrings in eccentric mode in the early weeks postoperative considering the harvest site as an equivalent of muscle tear.

Appropriate treatment of patellar dislocation in children and adolescents remains a subject of debate. Ligamentous transfer or "soft rod" is a technique for realigning the extensor mechanism that can be adapted to children. We analyzed results obtained in our patients.Between 1979 and 2000, 35 children (50 knees) underwent realignment which was combined in all cases with lateral retinacular release and medial reefing using the Insall procedure. Complementary procedures were needed in certain cases (quadriceps lengthening, femoral sulcus plasty, quadriceps release). Mean age at surgery was 11 years, range 5-15 years. All patients were reviewed at skeletal maturity with a mean follow-up of 7.5 years. The last review included a functional assessment using the IKDC form and standard x-rays (anteroposterior and lateral standing view and tangential view at 30 degrees flexion). A computed tomography scan and/or magnetic resonance imaging series were done preoperatively and at last follow-up.We distinguished two groups of patients, those with major (permanent or habitual) dislocation of the patella and those with recurrent dislocation. Functional outcome was good in 76% and 86% of knees respectively. There were eight cases of recurrent dislocation: five knees underwent revision surgery with good outcome. The femoral sulcus angle was improved in both groups, but especially in the congenital dislocation group. There was on case of reversed tibial slope (-2 degrees) ant to slopes at 0 degrees. Functional outcome was equivalent to results from earlier series (Grammont, Bensahel, Langeskiold), but comparison was hampered due to the heterogeneous nature of the different series. Femoral sulcus remodeling can enable good patellar stability if the surgery is performed early enough (before age 10 years). In teenagers with major instability, femoral sulcus plasty must be associated with the realignment procedure. We noted a small amplitude reduction of the tibial slope in eleven knees. The procedure appears to have an "epiphysiodesis effect" but with no functional consequence.Ligamentous transfer combined with different procedures is a method of choice for stabilizing the extensor system, enabling a normal femoral sulcus angle if the child is operated early. Remodeling of the tibial tuberosity could be related to a transient vascular disorder.

Traumatic muscular pathology is frequent in the athlete. Usually, these lesions heal spontaneously leaving no sequelae. One must be able to predict how long the healing process will last in order to avoid a long period of inactivity and to protect the patient from a recurrent tear. Medical imaging can define the precise location and severity of muscle traumas and detect critical elements that will delay complete repair. Sonography is the most useful and the least expensive imaging technique for analyzing muscular trauma. It provides a good study of muscle fibers, tendons, and aponeurosis but is limited in its poor visualization of the deep structures such as hamstring tendons and the difficulty in detecting muscular scar. MRI is the most sensitive imaging technique for analyzing muscular trauma. However, muscular fibers themselves are not visualized with MRI. It remains a secondary technique, adapted to the insufficiencies of sonography. Nevertheless, the exact place of medical imaging in traumatic muscular pathology remains and leaves the door open to many later studies.